The ‘Dry Drowning’ Debate: What You Need to Know

By Jennifer Clopton

June 12, 2018 -- Lacey Grace of Bradenton, FL, and her two daughters were playing in the pool at her parent’s house in April when the freak accident happened.

Her 4-year-old daughter, Elianna, was playing with a pool noodle, blowing water through it at another family member. When that person went to blow it back at her, the little girl put her mouth on the other end of the noodle at the same moment. So the preschooler inhaled a geyser of water as it rushed through the noodle and straight into her mouth.

“Elianna started gagging right away. We immediately pulled her out of the water and she threw up on the side of the pool,” Grace says. “We all looked at each other like -- is this dangerous? What just happened here?”

Within minutes, Elianna seemed back to her normal self, and 30 minutes later, she wanted to jump back into the pool.

But 2 days later, she got a low-grade fever. Then she stopped eating much and became extremely tired -- sleeping nearly an entire day away. When the fever came back 4 days after the pool incident, Grace took her to urgent care.

As soon as an urgent care doctor heard Elianna’s labored breathing and discovered she had low oxygen levels, he sent her to a nearby hospital, where she was admitted for 4 days.

The little girl’s official diagnoses involved inflammation in her chest and a bacterial infection in her lungs, which happens when liquid gets into the lungs or airways leading to the lungs rather than the esophagus or stomach. She needed antibiotics for the infection and got oxygen through a mask for 2 days before she could breathe on her own.

Neither Grace’s family nor the girl’s doctors called what happened to her “dry drowning” or “secondary drowning,” but plenty of people on social media have since Grace shared Elianna’s story on Facebook.

“It doesn’t matter to me what you call it. It was triggered by something in the pool, and I want people to know that if your child inhales pool water and has these symptoms, I encourage you to get it checked out,” Grace says. “That was the awareness I wanted to put out there.”

Debate Over ‘Dry Drowning’

While extremely rare, many parent reports of incidents of “dry drowning” or ”secondary drowning” have gone viral online. These terms, while not used by the medical community, are often used by parents and the media to describe cases where children swallow or breathe in water, but don’t show symptoms for hours or days.

“There is a disconnect between what parents perceive as drowning and what we as physicians diagnose as drowning,” says Rohit Shenoi, MD, a pediatric emergency medicine specialist at Texas Children’s Hospital in Houston.

The American College of Emergency Physicians (ACEP) calls the concept of “dry drowning” a “misnomer” and a “myth.” The group says this is a problem with wording, stressing that terms matter for an accurate diagnosis and proper public awareness. ACEP and many other medical groups have urged people to stop using these terms, saying they cause undue alarm and send parents to the ER for visits they don’t need.

“The fear that it creates in parents is dangerous because you have people panicking over something that simply can’t occur,” says Howard K. Mell, MD, an ACEP spokesman and emergency room doctor practicing in the Chicago area. “Every time one of these new stories comes out, emergency rooms are filled with parents wanting their kids checked for dry drowning. They don’t believe us when we tell them it isn’t a thing and their child will be OK. It can also backlog emergency departments.”

That’s not to say there aren’t risks with swimming or when children are near water. Drowning is defined as having trouble breathing after getting submerged in water. According to the CDC, it is the second leading cause of injury-related death in children between the ages of 1 and 4 and resulted in 3,786 deaths in 2016, the most recent data available.

But Mell says that if even a little water gets into the lungs of a child, this causes symptoms that you can notice right away, not ones that appear days later.

Doctors say if children ingest or inhale water, they can get complications in the hours or days afterward that include bacterial infections and pneumonia. Experts call it a “drowning injury,” or, as the CDC refers to it, “non-fatal drowning.”

“You either get immediate signs of distress or you get gradually developing symptoms as you develop inflammation, which sometimes can lead to pneumonia,” says James Chamberlain, MD, a pediatrics doctor in the emergency medicine division at Children’s National Health System in Washington, D.C. “It causes a lot of psychological distress for parents to think that the slightest little choking on water is going to somehow cause your child to die suddenly. That’s not the way it happens.”

Chamberlain says the development of pneumonia, an infection that happens after treatment for another infection, depends on how much fluid a child took in. “If they took in a small amount of fluid, your child will likely cough it out immediately, or it will be absorbed in lungs. But if a child absorbed a large amount, that would be more serious, and we would likely admit the child to the hospital.”

Grace’s daughter inhaled a lot of water, and her symptoms were severe. “The first night we were at the hospital, her oxygen level was dropping so quickly while she was sleeping and the alarms were going off like crazy, and she looked perfectly normal. So had I been home, I would never have known how much her body was struggling,” Grace says. “She was on oxygen for 2 days. She needed antibiotics for the bacteria in her lungs, and the fluid in the lungs leaves by itself, so we had to give that time.”

By comparison, Holly Loftin of Denver says her son Cort didn’t seem to take in much water when he was knocked over by a wave in 2015 at the age of 3 in Texas. And his symptoms, while concerning, were not as extreme as Elianna’s.

“My husband said he fell, swallowed a little and coughed, and that was it. According to my husband, it was uneventful. He went back to playing and seemed normal,” Loftin recalls.

But 30 minutes later, the boy’s face got red, he had a fever, and he got upset, uncomfortable, and started acting strange. Loftin says it was clear something was wrong, and they rushed him to the hospital. Doctors discovered he had a 105-degree fever and fluid in his lungs. They treated him and watched him for a few hours before sending him home.

“My son might have gotten a tiny amount of water, and because it was salt water, it caused an irritant,” Loftin says. “Some of the other cases you hear about, I think must involve more water.”

How to Protect Your Children

Despite reassurances from doctors, cases like Elianna’s and that of Frankie Delgado, Jr. -- a young boy who died in Texas in 2017 several days after inhaling a lot of water when he fell in while swimming with his family -- cause many parents concern. Delgado’s family told multiple news outlets the boy died of “dry drowning.” Experts say parents should focus on making sure to know what to do if children inhale a lot of water.

“If your child coughs, sputters, turns blue, etc., after swimming, watch them for 10-60 minutes. If they have any trouble breathing, continued coughing, or any signs of distress like falling unconscious or seeming really tired or confused -- basically if there is anything that really scares you -- call 911,” Mell says. “But if the symptoms clear completely, they are at no risk of having a drowning injury.”

Secondary infections, while extremely rare, are still possible. So watch for fever and other symptoms.

“If your child inhales … water, watch them for 2 to 3 days to see if the child is having labored breathing, worsening cough, or fever. If that happens, make sure they are seen by a doctor because they could develop pneumonia if they [inhaled] some fluid into the lungs,” Shenoi says.

General water safety is key, too. Doctors say parents need to stay vigilant when their children are around water, since it only takes a small amount for children to accidentally drown.

“You need to watch your children. Children who are drowning may not call for help or scream or wave their arms. They may silently go under, so you really have to be paying attention,” Chamberlain warns.

Experts also recommend:

Swimming lessons for children

CPR training for adults

Life jackets -- especially on a boat or other water vehicle

Be aware of waves and rip currents at the beach.

Don’t drink alcohol while watching your children near water.

People who have witnessed a frightening water accident with their children say it’s important to talk about because they don’t want it to happen to anyone else.

“It was so scary,” Grace says, adding that it was 2 weeks before her daughter’s lungs cleared out and her infection went away.

“I don't necessarily want to ‘warn’ parents, but I just want to bring awareness. While it is an extremely rare situation, it can be deadly if left untreated,” she says. “Elianna was turning for the worst after only 4 days.”

“It’s definitely changed how I am at the pool,” Loftin agrees. “I am a lot more cautious. A lot more cautious.”